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AAP updates interim guidance on child care during COVID-19 :

October 26, 2020

Editor’s note: The AAP has updated its guidance since this article was published. Please visit the updated interim guidance. AAP interim guidance is based on current evidence and best data at the time of publication. Updates are provided to reflect changes in knowledge about the impact of the disease on children and adolescents.For the latest news on COVID-19, visit

The AAP has updated its interim guidance on child care with in-depth discussions of general preparedness, redesigning the learning environment, infection control and special populations.

The guidance includes new advice on supporting emotional and behavioral health, what to do when someone becomes sick and a downloadable symptom checklist. It also has expanded information about well child care, cleaning/disinfection and consultant access to programs.

“Early care and education programs including child care, family child care, and Head Start programs offer a supportive learning environment for healthy child development as well as a foundation of services for young children and their families,” the AAP wrote in Guidance Related to Childcare During COVID-19. “The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of these services such as provision of healthy meals, referrals to community resources, and social connections for children and families.”

General preparedness and planning

Child care programs can adapt existing emergency preparedness policies to the COVID-19 pandemic using guidance from local health departments and the Centers for Disease Control and Prevention (CDC).

During the pandemic, fewer children have been receiving developmental screening and well-child care including vaccinations. The AAP is stressing the importance of these services, especially for children returning to group settings. Early intervention services, development of Individualized Family Service Plans and Individualized Education Programs also must continue, although they may need to be adapted during the pandemic.

Child care programs should perform daily health checks for staff and children before drop-off that include a check of their temperature, COVID-19 symptoms and history of contact with a confirmed case of SARS-CoV-2, according to the guidance.

Programs also should have a plan for responding if a child becomes sick during the day. The CDC recommends isolating the sick child with appropriate supervision until the child can return home.

CDC guidance also should be used for self-isolation for suspected or confirmed cases of SARS-CoV-2 and quarantine for cases with history of close contact to a confirmed case. If a child, household member or staff member has a confirmed case of the disease, the child care program should work with local health officials to determine whether the center needs to close.

Redesigning the learning environment

State or local health officials may set reduced capacity limits for child care centers. The AAP recommends using a cohort model to keep children and staff in groups that do not mix and giving these cohorts more space than usual to spread out if possible.

Using outdoor spaces also can be helpful, but children should stay in cohorts, and staff should clean equipment between each classroom’s use.

Drop-off and pick-up times likely will look different during the pandemic. Programs should keep children in their cohorts at these times and stagger them. They also should limit direct contact with parents and guardians, and staff should wear appropriate personal protective equipment (PPE).

Early intervention, speech therapy and mental health consultation should continue but may need to be virtual. Consultants who enter the room should take the same precautions as staff.

Child care providers should be on the lookout for children experiencing fear, stress and anxiety, which may manifest in behavioral issues. Staff should remain calm, offer them comfort and keep them engaged in their program.

 The guidance also covers support for breastfeeding mothers, suggesting that they have private spaces with adequate ventilation for pumping or breastfeeding and that all surfaces are cleaned after each use.

Infection control

The AAP encourages increased hand hygiene during the pandemic, preferably with soap and water. Staff and children over age 2 years should wear cloth face coverings, although children should not be reprimanded or punished for not wearing one.

Programs should ensure they have an adequate supply of face coverings, smocks, gloves and face shields. Face coverings should be replaced if they become wet or soiled and should be washed at the end of every day.

Normal cleaning procedures should take place at the end of each day. Soap and water should be used first followed by Environmental Protection Agency-registered household disinfectants. No special cleaning products are necessary. If toys or equipment become soiled with dirt or bodily fluid, they should be cleaned immediately. Soft toys should be removed as they are hard to clean.

Cleaning staff should wear disposable gowns and gloves. Those who wear washable clothing should launder it after cleaning. Child care programs also may consider consulting with a licensed heating, ventilation and air conditioning expert to ensure ventilation systems operate effectively.

Special populations

Children with special health care needs may be at increased risk for severe illness from SARS-CoV-2. Parents and child care staff should use shared-decision making about their attendance in child care and update their individualized health plans. Regular communication, creativity and flexibility will be key for children’s attendance.

As is standard practice, staff should perform enhanced handwashing and consider wearing a hair cover and tying up their hair.

Children with asthma should have an updated asthma action plan. The AAP recommends they take medications through an inhaler instead of a nebulizer. Experts continue to review emerging data as to whether aerosols generated by nebulizer treatments are potentially infectious.

 The guidance also includes special considerations for family child care. It recommends limiting family members from interacting in the child care space and taking extra precautions when preparing and serving meals.

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